Care Home: The Willows

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What the care home does well People living at The Willows are positive about the standard of care they receive. The home is clean and tidy. Improvements have taken place regarding the filing of documents within a new office. What the care home could do better: As indicated above the service needs to improve in some areas. The records regarding medical care needs were insufficient to demonstrate that staff had taken the necessary actions to ensure that they were being met or did not require attention from community nurses. The safe storage of medication needs to be accurate by means of ensuring the temperature of the room used is within a safe limit. The practice regarding the management of controlled medication needs to be improved to ensure people are safeguarded. Other improvements regarding medication practice include the booking in of medication and ensuring that information about people`s prescribed medication is not conflicting. Practices and the following of safe procedures need to be improved in relation to the recruitment of new members of staff. This is needed to ensure that people who are unsuitable to work within a care environment do not gain employment. Details of staff training needs to be available in order that the home can demonstrate how employees skills and knowledge are maintained. Equipment within the home needs to be tested and maintained to ensure that it is safe to be used. Random inspection report Care homes for older people Name: Address: The Willows 2 Tower Road Barbourne Worcester Worcestershire WR3 7AF one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Andrew Spearing-Brown Date: 1 0 0 5 2 0 1 0 Information about the care home Name of care home: Address: The Willows 2 Tower Road Barbourne Worcester Worcestershire WR3 7AF 0190520658 Telephone number: Fax number: Email address: Provider web address: willows2@btinternet.com Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Vivien Anita Harborne,Mr Tony Harborne care home 14 Number of places (if applicable): Under 65 Over 65 14 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 14 Date of last inspection Brief description of the care home The Willows is a large, detached, adapted property situated in a residential area near to Barbourne Park in Worcester. The home provides accommodation and personal care Care Homes for Older People Page 2 of 12 Brief description of the care home to a total of 14 people who have needs related primarily to old age. Accommodation is located on two floors, with access to the first floor gained via a staircase and or a stair lift. Handrails are fitted throughout the home. Accommodation comprises of 14 single bedrooms, all of which have en-suite facilities. The home has one large lounge and a separate dining room. The home has a well maintained garden to the rear of the property. People using the service are able to use a patio area which can be reached from either the main lounge or dining room. Limited car parking is available to the front of the property. For up to date information about fees charged at The Willows the reader should contact the service directly. Care Homes for Older People Page 3 of 12 What we found: This inspection was unannounced. Therefore nobody within the home knew we would be coming. This inspection was carried out by one regulatory inspector over a period of one day. The last key inspection at The Willows was carried out during September 2009. The outcome of that inspection was that we changed the quality rating to Adequate. Since the last key inspection a new manager has commenced work at the home. At the time of this inspection an application had been submitted to the commission for registration. During our visit we looked at some documents such as care records, medication records, staffing records and servicing records. We spent time having a look around the home and observing what was happening. We spent time with the manager designate and the lead carer. We had discussions with one of the providers, some members of staff and some people residing within the home. Prior to our visit we had requested an Annual Quality Assurance Assessment (AQAA) from the service. This was completed by the manager designate. The AQAA is a document within which services are able to demonstrate to us where they believe they are providing a quality service. In addition the AQAA is a means within which services are able to tell us about areas they believe they could improve in the future. We received questionnaires back from some people living in the home and some members of staff. We have taken these into account within this report. Information is provided by the service for people who may potentially use the service. We saw a supply of colour brochures located near to the front door. The Statement of Purpose dated 30th September 2009 stated that The person officially registered to manage the home is Mrs Susan Powell who is the person in day to day control of the homes operations. As indicated above although an application has been made to the Care Quality Commission the fit person interview had not taken place therefore no decision had been reached regarding registration. As part of this random inspection we viewed the care plans and daily records regarding some people living at The Willows. A care plan is a document designed to give staff guidance about the care needs of people in order that service delivery is consistent. Everybody had a care plan and we saw that reviews take place. However we noted some concern with each plan we viewed in relation to a health care need. We saw some information within the records of one person regarding a doctor setting up an appointment for a resident with a diabetic specialist. Later the records showed that a community nurse had visited the home to carry out a blood test of which the home was awaiting the result. The test had happened over two weeks before our visit. We asked what the results were. Nobody within the home had any knowledge of the outcome. We saw a body map on which a member of staff had recorded that the individual concerned had very sore skin and very red groins. The records showed that a Care Homes for Older People Page 4 of 12 community nurse attended and ordered some cream. This cream was not recorded upon the medication records and when we asked key staff about this cream they had no knowledge of it. This cream was found in the persons bedroom but we were unable to establish what regime was in place regarding its usage as staff we spoke to did not know. Within the records of another person we saw that a community nurse had visited a person up until the resident concerned was admitted into the home. Reference to problems with the persons heels was also mentioned upon the assessment given to the home upon admission. The care plan stated that ointment and cream was prescribed and that the skin can become dry in appearance. There were no creams or ointments on the medication sheets and none were known about. Staff on duty informed us that community nursing services had not visited the home to see this person since admission. People were not able to tell us whether the heels needed medical input without checking them out. Other records held showed that peoples weight is maintained. We also saw records demonstrating that a chiropodist visits the home. Within the AQAA the manager designate wrote, in relation to medication, that a recent audit from the PCT (Primary Care Trust) was excellent. We saw a letter from the pharmacy who supply medication to The Willows which described the maintenance of records, storage and the administration of medication to be of an adequate standard. The records from the PCT visit highlighted no concerns. We looked at a sample number of the current months Medication Administration Record (MAR) sheets. These were generally found to be in good order with a signature showing that medication was given as prescribed. The home receives medication on a weekly basis. We found that the home does not record that medication is checked into the home. Having a system in place in place ensure that the right medicines are received and enable auditing to take place. The service has a fridge dedicated to storing medication. A report from the supplying pharmacy dated January 2010 brought to the attention of the home that some creams and eye drops were stored in the fridge contrary to their required storage. During this inspection we viewed the fridge and found that it still contained items which did not need refrigeration. We asked whether a record of room temperature was maintained. We were informed that a thermometer was in place but no record kept. We asked if people knew what the temperature should be within the room. The people we spoke to were not able to tell us. The room temperature was below 25 degrees Centigrade which is in line with manufactures guidelines for safe storage. We viewed the controlled drugs register (CDR) and checked the number of tablets stored within the home. We found the number to be incorrect according to the CDR. On examination of the CDR we found an error in the subtracting which had gone unnoticed for a few days. People on duty, including the manager designate confirmed that they do not count the actual amount of medication remaining. This would mean that in the event of controlled medication going unaccounted for the home would not pick this up at the time of the next administration. In addition staff had failed to record the date within the CDR for a period of four days. Care Homes for Older People Page 5 of 12 We saw a board near to the dining room listing a range of activities. This was not an indication of events scheduled for that day but was a list of events that could potentially take place at some point in the future or events that had happened. Some small photographs were displayed outside the lounge of events that have happened within the home. During our visit we saw staff leading a group activity as well as staff engaging in one to one discussions with residents. Throughout our inspection we saw staff being considerate and caring towards residents. One person living within the home told us that the staff are kind. On the questionnaires returned to us and completed by people living at The Willows people had written nice staff care for people here new staff are nice. Over recent inspections we have brought to the attention of the providers the fact that people raise with us that powdered milk is used within the home. The manager designate showed us a milk pergal and assured us that fresh milk is now always available. Information was available within the home regarding how people can complain about the service provided. Within our previous report we mentioned that a complaints procedure was attached to the inside of every bedroom door. We commented upon the size of the font and the fact that it made no reference to the Care Quality Commission. The manager designate was not sure whether these were still in place. We checked one bedroom and found that it was still there. Since our last inspection the home has not received any complaints regarding the quality of the service provided. The manager designate has recorded a small number of concerns raised and the action taken to resolve things. We have previously required that staff are provided with information regarding the action they need to take in the event of them suspecting abuse or neglect within the home. At the time of our previous inspection we were informed that scheduled training was postponed by the trainer. We were informed that since that date training has now taken place involving all members of staff other than those who have commenced duties in the meantime. The Willows continues to offer comfortable homely accommodation for people who live there. People are able to relax in the communal lounge. Limited seating is available in the entrance hall, this area continues to be a popular place to sit. A smaller lounge is now used as a room to store medication and peoples care records. The dining room, which is a pleasant place to eat, is sufficient in size to accommodate everybody living in the home. Since our last inspection one of the providers has painted the hallway, staircase and landing. These areas now look clean and welcoming. All the bedrooms are single occupancy and they all offer en-suite facilities. We saw a small photograph of each occupant displayed on their bedroom door. Over recent inspections we have made comments about the carpet along the ground floor, the staircases and the upstairs leading. This carpet is showing signs of wear and tear and is stained in places. Care Homes for Older People Page 6 of 12 At the time of our last inspection we noted that some slabs on the patio area were loose while others were uneven. We were informed that work has now taken place to resolve the above risk. The back garden appeared to be well maintained. When we arrived at the home two carers and a senior carer were on duty in addition to the manager designate. Another carer was working within the kitchen preparing breakfast. Since our last inspection a kitchen domestic has been appointed who now works two mornings a week. Carers continue to prepare the afternoon tea. The manager designate has changed staffing arrangements during the night. As a result two carers are now on wakeful duty rather than having one of them sleeping in. The manager designate has worked with the local job centre to recruit some new members of staff. We have previously had concerns about recruitment practices at The Willows. We viewed the documentation regarding three new employees. Although the service had obtained a CRB (Criminal Records Bureau) discloser in relation to each person we did nevertheless still have some concerns. One application form named one referee. A reference was obtained from that person. The other reference was written by the manager designate who was previously the applicants manager. We saw reference to a period of time the applicant had spent at another care home however this was not mentioned on the application form. We spoke to the manager designate about the contents of a reference regarding another member of staff. We were informed that the details were discussed with the author but this was not recorded. The dates of employment on the application form and the reference did not match, this discrepancy had not been noticed and therefore not followed up. On another file we saw a reference however the manager designate could not tell us who it was from. The manager designate stated that she had needed to start the training matrix again as information about previous training undertaken could not be found within the home. From the information we saw it was evident that staff training has taken place recently. We were told about forthcoming training in areas such as first aid and food hygiene. During our visit we were informed that 4 members of staff are now signed up to commence NVQ (National Vocational Qualification) training. All other carers have, we were told, achieved this award. A certificate of employees liability insurance was on display in the manager designate office. However this had an expiry date of 23rd January 2010. The manager designate did not know where a new certificate was. Prior to this inspection we noted that the AQAA was incomplete in some areas including giving details when some servicing of equipment had taken place. We viewed a document completed following a visit to the home during December 2009 from a health and safety officer employed by Worcester City Council. We saw that the officer requested a number of documents which were not available for inspection at that time. One of the documents requested was in relation to the servicing of hoisting equipment. We have, on a number of occasions, in the past brought to the attention of the provider guidance from the Health and Safety Executive (HSE) regarding equipment that lifts people. This guidance states that The lifting Operations and Lifting Equipment Regulations 1998 require that Care Homes for Older People Page 7 of 12 personal lifting equipment (hoists and lifts for people) are thoroughly examined every six months unless a separate thorough examination scheme is devised by a competent person. The service was unable to provide evidence that recent servicing had happened. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Regulation 12 (1) The service must ensure that the medical care needs of residents are met and that records are kept up to date regarding the actions taken This is to ensure that peoples well being is maintained. 31/05/2010 2 9 13 Regulation 13 (2) The service must ensure that medication which needs to be treated as controlled has accurate records maintained as required by the Misuse of Drugs Regulations (Safe Custody 1973), the Misuse of Drugs Act 1971 and as in guidance issued be the Royal Pharmaceutical Society of Great Britain. This is to ensure that systems within the home are safe. 31/05/2010 3 9 13 Regulation 13 (2) 31/05/2010 Page 10 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action The service must ensure that medication is stored at the correct temperature recommended by the manufacturer. This is to ensure that medication does not deteriorate which can make the medication ineffective and possibly harmful to people living in the home. 4 38 13 Regulation 13 (4) The service must ensure that suitable arrangements are in place to ensure that the servicing of equipment takes place. This is to ensure that people are not placed at risk. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/05/2010 1 29 Practices within the home regarding the recruitment of new employees need to be improved in order to ensure that they are robust in order to prevent unsuitable applicants gaining employment within the home. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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